Liver Diseases in the Perinatal Period: Interactions Between Mother and Infant

Abstract

Liver diseases affecting the mother and infant dyad may present in the perinatal period from 20 weeks of gestation to 28 days of life. This review will focus on the current approach to neonatal acute liver failure and the progress made in the diagnosis and management of gestational alloimmune liver disease. It will highlight mother-to-child transmission of viral hepatitis, both management and public health implications. Emerging concepts implicating maternal obesity and nutrition in the development of a rapidly progressive nonalcoholic steatohepatitis phenotype in the offspring will be discussed. Finally, the presentation and management of acute fatty liver of pregnancy and intrahepatic cholestasis of pregnancy, and their impact on the fetus, will be reviewed.

Figure 1.. Disease mechanism of GALD-NH.

Alloimmune injury to nascent hepatocytes results in reduced hepatocyte mass and impaired synthesis of angiotensinogen and hepcidin that regulate renal tubular development and maternal-fetal iron transport, respectively. Loss of inhibitory feedback leads to ongoing proliferation and a compensatory increase in hepatic parenchymal tubulogenesis and fibrosis.

Figure 2.. Perinatal events promoting NAFLD in the offspring and therapeutic interventions.

Maternal risk factors promote NAFLD in the offspring through mitochondrial dysfunction, alterations of the epigenome, dysbiosis and immune dysregulation. Treatment can be initiated during pregnancy, via lifestyle and pharmacological interventions (preclinical phase agents are marked with question marks), as well as postnatally.

Figure 3.. Algorithm for the diagnosis and management of AFLP.

Hemolysis, elevated liver enzyme levels, and low platelet (HELLP), intrahepatic cholestasis of pregnancy (ICP)

Figure 4.. Intrahepatic Cholestasis of pregnancy.

A) Genes and transporters in the hepatocyte involved in the pathogenesis of ICP. B) Factors contributing to the etiology of ICP.